PTCL Treatment in the Community Setting

Insights From: Stephen M. Ansell, MD, PhD, The Mayo Clinic

Published: Monday, Jan 28, 2019

Transcript:

Stephen Ansell, MD, PhD: Right. So this was a different abstract that actually looked at what’s the real-world experience with peripheral T-cell lymphoma [PTCL]. And as we mentioned earlier, we said that it’s really been a challenge to treat peripheral T-cell lymphoma because these patients generally don’t respond as well or as durably as we’ve seen with other lymphomas. So this was an analysis of relapsed and refractory patients to say, well, how did they do? The interesting thing was, in general, patients responded very well to frontline therapy. In that study, about 80% of people had benefit to frontline treatment. The challenge, however, was it wasn’t as durable as one would hope, with a very high percentage of patients subsequently relapsing. And then when you said, well, how did they do with second-line therapy? Could they get to transplant? Did the transplant actually result in durable remissions? The results were actually quite poor.

So all of that just really emphasized the fact we need new agents to treat patients with peripheral T-cell lymphoma. And now, as we said, a subset of patients, those who express CD30, we have an agent that really is making a difference that’s moved all the way back into frontline. So hopefully the high relapse rate will now be permanently affected, particularly in the CD30 fraction.

So I think that is a multifaceted question. I think, in general, folks in the community do a very good job of following the data, and as new therapies become standard, they would typically follow that. And I think, in general, those following the current guidelines result in good outcomes for patients. I think T-cell lymphomas have a little bit of a unique wrinkle to them in that some of them have a very unusual presentation. So, for example, there’s an enteropathy-associated T-cell lymphoma where patients have substantial difficulty with absorption and can be very sick just from the presence of lymphoma in their bowel. That’s not a very common disease. So many people in the community who may see such a patient have limited experience.

So I think when you have the rare subtypes where they have complicated presentations and often are very sick patients, those patients are best served at a specialty center, just because I think all of the additional help with nutrition, for example, in that case, would be critical. But in the more typical peripheral T-cell lymphoma that’s more nodal-based, I think oncologists generally do a good job of managing those patients, particularly if they follow the current recommendations.

Transcript Edited for Clarity

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Transcript:

Stephen Ansell, MD, PhD: Right. So this was a different abstract that actually looked at what’s the real-world experience with peripheral T-cell lymphoma [PTCL]. And as we mentioned earlier, we said that it’s really been a challenge to treat peripheral T-cell lymphoma because these patients generally don’t respond as well or as durably as we’ve seen with other lymphomas. So this was an analysis of relapsed and refractory patients to say, well, how did they do? The interesting thing was, in general, patients responded very well to frontline therapy. In that study, about 80% of people had benefit to frontline treatment. The challenge, however, was it wasn’t as durable as one would hope, with a very high percentage of patients subsequently relapsing. And then when you said, well, how did they do with second-line therapy? Could they get to transplant? Did the transplant actually result in durable remissions? The results were actually quite poor.

So all of that just really emphasized the fact we need new agents to treat patients with peripheral T-cell lymphoma. And now, as we said, a subset of patients, those who express CD30, we have an agent that really is making a difference that’s moved all the way back into frontline. So hopefully the high relapse rate will now be permanently affected, particularly in the CD30 fraction.

So I think that is a multifaceted question. I think, in general, folks in the community do a very good job of following the data, and as new therapies become standard, they would typically follow that. And I think, in general, those following the current guidelines result in good outcomes for patients. I think T-cell lymphomas have a little bit of a unique wrinkle to them in that some of them have a very unusual presentation. So, for example, there’s an enteropathy-associated T-cell lymphoma where patients have substantial difficulty with absorption and can be very sick just from the presence of lymphoma in their bowel. That’s not a very common disease. So many people in the community who may see such a patient have limited experience.

So I think when you have the rare subtypes where they have complicated presentations and often are very sick patients, those patients are best served at a specialty center, just because I think all of the additional help with nutrition, for example, in that case, would be critical. But in the more typical peripheral T-cell lymphoma that’s more nodal-based, I think oncologists generally do a good job of managing those patients, particularly if they follow the current recommendations.